| NPI | 1962889030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN GOMEZ-BARTEK Owner Dentist 505-310-3603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DD2992) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-04-28 |